Parakeratosis is a keratinization disorder of the skin that is usually associated with skin diseases such as psoriasis, eczema, or Bowen’s disease. The primary cause of parakeratosis may be an acceleration of cornification processes or a disorder of keratinocyte maturation. Treatment depends on the primary cause and additional skin disorders present.
What is parakeratosis?
During keratinization or keratinization, epithelial cells remodel into horn-forming keratinocytes and become horn cells called corneocytes. Keratinocytes or horn-forming cells are cells of the epidermis or epidermis that make up 90 percent of this skin layer. The cell type is capable of producing keratin and thus differentiates during cornification. Keratinization processes occur physiologically within the epidermis and can also occur in various mucous membranes. Cornification increases the mechanical stability of skin surfaces. The cornification process can be disturbed by various diseases. One of them is parakeratosis. This form of dyskeratosis is characterized by cell nuclei or cell nucleus remnants that remain in the horny layer. In many cases, the horny layer thickens at the same time. This phenomenon is also called parakeratotic hyperkeratosis. If parakeratosis and increased keratinization in the sense of hyperkeratosis occur together, it is called hyperparakeratosis.
Causes
Parakeratosis can have different causes. In addition to an accelerated course of keratinization processes, a maturation disorder of keratinocytes may be responsible for the phenomenon. Both phenomena may be due to hormonal correlations. Typically, parakeratosis in humans is associated with diseases such as psoriasis, eczema or Bowen’s disease. The skin changes of Bowen’s disease are often related to exposure to sunlight, chemicals such as arsenic, or certain viruses such as HPV. Men are more often affected by the phenomenon than women. A multifactorial genesis is assumed for psoriasis. In addition to genetic dispositions, immunological dysfunctions are discussed in this context. In this context, immunological dysfunction corresponds to an autoimmunological reaction in which the immune system is directed against the body’s own tissue. The trigger for immunological dysfunction has not yet been conclusively clarified for any autoimmune disease. Under discussion are, for example, preceding infections.
Symptoms, complaints, and signs
Patients with parakeratosis suffer from a cornification disorder in which cell nuclear remnants remain in the cornea. Additional thickening of the affected skin layers is frequently observed. Diseases such as psoriasis often accompany parakeratosis. Typically, psoriasis manifests itself in the form of monomorphic, reddish, mostly roundish and island-shaped foci with sharp borders and slight elevation. Instead of psoriasis, parakeratosis may also be associated with the skin lesions of Bowen’s disease. On the skin, Bowen’s disease appears in the form of scattered and irregularly shaped skin lesions with sharp borders. The lesions appear broad and bear a red scaly appearance. The size of the lesions varies from a few millimeters to decimeters. Unlike psoriasis, Bowen’s disease usually presents with a single focal lesion. In addition, the combination of parakeratosis and eczema is common. Eczema is an inflammatory lesion of non-infectious origin that occurs together with skin redness, vesiculation, and weeping and crusting or scaling. In parakeratosis, painful areas and skin dryness may occur in addition to psoriasis, eczema, and Bowen’s disease.
Diagnosis and course of the disease
The diagnosis of parakeratosis is made by the dermatologist. In most cases, the visual diagnostic impression after history taking is sufficient to make the diagnosis. Instruments for magnification may be consulted to better identify the retained cell nuclei. The detection of the typically occurring cell nuclei within the cornea is sufficient to confirm the diagnosis.The prognosis for patients with parakeratosis depends on the primary cause. The nature of the accompanying symptoms can also play a decisive role in the prognosis. For example, psoriasis has been considered an incurable disease of the skin.
Complications
Due to parakeratosis, the patient develops various diseases and complaints of the skin. These usually have a very negative effect on the aesthetics and thus also on the quality of life of the affected person and limit it. In most cases, this involves psoriasis and thus a cornification disorder. Many affected persons feel uncomfortable with the complaints or are ashamed of them, so that a significantly reduced self-esteem or inferiority complexes can occur. Psychological discomfort and depression may also occur, and are particularly aggravated by bullying or teasing. Furthermore, the skin is reddened and may also itch. Constant scratching can also lead to scars or bleeding on the skin. The skin itself is dry and scaly in parakeratosis. Treatment of parakeratosis is usually not associated with complications. With the help of various medications and therapies, the symptoms can be relatively well limited. The patient’s life expectancy is also not reduced due to the disease. At times, sufferers may need to rely on light therapy to limit the disease completely.
When should you see a doctor?
Peculiarities and abnormalities of the skin appearance should be examined and clarified by a physician. If the affected person suffers from thickening of the skin or the formation of a callus, a visit to the doctor is advisable. If the skin discrepancies cannot be improved by taking care measures on one’s own, seeking medical help is advisable. Various skin care preparations are available in drugstores and pharmacies and can be tried out. If the symptoms persist over a longer period of time or spread continuously over the body, an intensive examination of the skin is recommended. If there are changes in the usual appearance of the skin, it is necessary to consult a doctor. Inflammation on the body or the formation of pus are considered worrisome. If the affected person cannot ensure sterile wound care, a doctor should be consulted. There is a risk of blood poisoning in severe cases and thus a potential threat to life. Discoloration of the skin, redness and the formation of eczema should be examined by a specialist. If blisters develop or scaly skin occurs, medical advice should be sought. Pain, general malaise, or emotional problems should be discussed with a physician. If there is withdrawal from social life, mood swings or depressive behavior, help is needed.
Treatment and therapy
Causative therapy is conceivable for parakeratosis only under certain circumstances. A slowing down of the keratinization processes can usually not take place sufficiently. Maturation disorders of the keratinocytes, on the other hand, can be influenced to a certain extent. For symptomatic therapy, mainly conservative medicinal therapy options are available against skin dryness. In most cases, these are ointment treatments containing the necessary active ingredients. If parakeratosis occurs in the context of another skin disease, further therapy is required. Eczema is treated externally with ointments, the consistency of which is chosen depending on the skin condition. Acute weeping eczema requires treatment with relatively watery ointments. If crusts or scales are present, a greasy ointment base should be chosen. Under certain circumstances, the ointments are also applied in the form of a poultice. All inflammatory reactions of the skin are suppressed with glucocorticoid compresses. Patients with parakeratosis must avoid irritating substances for the time being. If psoriasis is also present, treatment approaches range from dietary changes to electrical treatment and bath and light therapy to drug approaches such as corticosteroids. If Bowen’s disease is also present, either excision of the affected skin areas or photodynamic therapy is performed. In the case of excision, a subsequent analysis of the cut edge must be performed, which may provide the impetus for a re-excision.
Outlook and prognosis
Parakeratosis offers a relatively good prognosis. The keratinization of the skin can be treated by various medications and therapies. Often, treating the causes is sufficient to contain parakeratosis. During the disease phase, parakeratosis limits the quality of life and well-being. Typical complaints such as the itching, the scaling or the mental stress should disappear after the treatment is completed. Life expectancy is generally not limited by parakeratosis, as it is not a fatal disease. However, inflammation or other medical complications can develop if the affected areas are scratched open or improperly treated. In general, however, parakeratosis patients have the prospect of recovery. The prognosis is worse when parakeratosis occurs in conjunction with hyperkeratosis. Such hyperparakeratosis can cause nail changes, sores, and other medical sequelae associated with severe discomfort. The use of aggressive medications such as ointments containing high levels of urea is necessary, which may result in further health limitations. The prognosis is made by the dermatologist in charge with regard to, among other things, the severity of the disease and the general condition of the patient. In the case of severe concomitant diseases, the other physicians must be involved in the prognosis setting.
Prevention
To date, parakeratosis cannot be successfully prevented.
Aftercare
In most cases, the measures of direct aftercare for parakeratosis are severely limited. The further course of this disease is very much dependent on the time of diagnosis and also on the severity of the symptoms, so that a general prediction is usually not possible. For this reason, the affected person should consult a doctor at the first symptoms and signs of the disease in order to prevent the occurrence of further complications and complaints. Self-healing usually cannot occur with parakeratosis. Most sufferers depend on the use of various creams or ointments. It is always necessary to pay attention to a correct dosage with a regular application. Likewise, regular contolls by a doctor are very important, and the support of friends and family is also very important. This can prevent or alleviate depression or other psychological upsets. A complete cure cannot always be achieved, so contact with other people affected by parakeratosis can also be very useful. This leads to an exchange of information, which can facilitate the everyday life of the affected person.
What you can do yourself
In the case of parakeratosis, treatment is not necessarily necessary. If the symptoms are very pronounced, foods with zinc and iron are recommended. The minerals improve the appearance of the skin and help reduce the disorder of keratinization. The affected areas should be carefully cared for and, if necessary, treated with a cleansing ointment. The care products used contain minerals and anti-inflammatory substances that alleviate the acute symptoms and lead to a reduction in cornification in the long term. The family doctor can prescribe the appropriate preparations and give further tips for the treatment of parakeratosis. In most cases, it is sufficient to take it easy on the affected areas. To avoid further keratinization on the feet, excessively tight footwear should not be worn. If parakeratosis occurs in another region of the body, any triggers or amplifiers of the condition must be identified. Often, clothing that is too tight contributes to keratinization. If the parakeratosis rapidly becomes more severe, the doctor must be called in. It is possible that the disturbed keratinization is based on a serious disease, which must be examined and treated. Removal of keratinization by means of a corneal plane should only be carried out in consultation with the dermatologist.
